Information Collection

Post-Technical Assistance Evaluation (PTAE)

IC 242739 under ICR 202407-0920-005 · OMB 0920-1322.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1322 Post-Technical Assistance Evaluation (PTAE)	Form
0920-1322 Post-Technical Assistance Evaluation (PTAE) Att 10_Post-Technical Assistance Evaluation-Screenshots.docx	Form
0920-1322 Post-Technical Assistance Evaluation (PTAE) Att 10_Post-Technical Assistance Evaluation-Screenshots.docx	Form
0920-1322 Post-Technical Assistance Evaluation (PTAE) - WORD Att 9_Post-Technical Assistance Evaluation-Word version.docx	Form
0920-1322 Post-Technical Assistance Evaluation (PTAE) - WORD Att 9_Post-Technical Assistance Evaluation-Word version.docx	Form
Att 8_Post-Technical Assistance Evaluation Introductory Email.docx Post-Technical Assistance (TA) Evaluation Introduction Email	IC Document
Att 8_Post-Technical Assistance Evaluation Introductory Email.docx Post-Technical Assistance (TA) Evaluation Introduction Email	IC Document

IC Title:

Agency IC Tracking Number:

0920-1322

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-1322	Post-Technical Assistance Evaluation (PTAE)	Att 10_Post-Technical Assistance Evaluation-Screenshots.docx		Yes	Yes	Fillable Fileable
Form	0920-1322	Post-Technical Assistance Evaluation (PTAE) - WORD	Att 9_Post-Technical Assistance Evaluation-Word version.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Records of Health Professionals in Disease Prevention and Control Training Programs.

FR Citation: 51 FR 42485

Number of Respondents: 3,650

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	7,300	7,300
Annual IC Time Burden (Hours)	608	608
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Post-Technical Assistance (TA) Evaluation Introduction Email	Att 8_Post-Technical Assistance Evaluation Introductory Email.docx	08/01/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.